SEARCHLIGHT
Navigating the Global Medical Network
Of Sexual Health Issues for Sexual Health Matters
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You are welcome to this column in Sexual Health Matters that will regularly
navigate the medical world to flag recent development in Sexual Health issues.
There will be opportunity to take part in regular problem based searchlight
medical exercises. The columnist welcomes regular feedback from readers through
the feed back e-mail. Enjoy your reading.
Pornography and sexual behaviour
Pornography is created mainly for the male consumer, and is especially available
on the Internet. It is estimated that the online pornography industry is already
worth up to 1 billion U.S. dollars (USD). It is likely that a majority of women
will be exposed to pornography, whether they want it or not. A Swedish study
by Christina Rogala and Tanja Tydén1 examined the relationship between
pornography and female sexual behaviour. Wit the help of a structured questionnaire,
they interviewed 1000 young women visiting family planning clinics in Stockholm.
The women were asked about their sexual behaviour and if they had seen pornography.
Four out of five had consumed pornography, and one-third of these believed that
pornography had an impact on their sexual behaviour. As many as 47% had experienced
anal intercourse, which was significantly more common among older women (51%)
than among teenagers (31%). The majority valued anal intercourse as a negative
experience. The use of a condom was low (40%) when having anal intercourse,
so the consequences for the spread of sexually transmitted diseases should be
considered.
1. Christina Rogala and Tanja Tydén . Does pornography influence young women's sexual behaviour. Women’s Health Issues Vol 13, issue 1 39-43.
Stress Incontinence, smoking and lifestyle factors-The Norwegian EPINCONT
Study.
A cross sectional population-based study1 of the Norwegian Epidemiology of Incontinence
in the county of Nord-Trondelag (EPICONTI) is reported. This study was to examine
whether modifiable lifestyle factors such as smoking, obesity, physical activity
and intake of alcohol or caffeinated drinks were associated with urinary incontinence
in women. More than 34,000 women aged 20 years or more were surveyed. Each individual
at a screening station completed a structured questionnaire covering several
health topics including urinary incontinence. Logistic regression analysis was
used to adjust for confounding factors and to establish associations with the
different outcomes under investigation: any incontinence, severe incontinence
and stress, urge and mixed subtypes.
Several potentially modifiable lifestyle factors are associated with urinary
incontinence. The highest Odds ratios were found for body mass index, heavy
smoking and tea drinking.
1. Yngvild S. Hannestad, Guri Rortveit, Anne Kjersti Daltveit and Steinar Hunskaar. Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study. BJOG: An International Journal of Obstetrics and Gynaecology Vol 110, Issue 3 , March 2003, Pages 247-254
Steroid therapy for postpartum HELLP syndrome: Dexamethasone versus
betamethasone.
The efficacy of dexamethasone and betamethasone was compared to ameliorate the
course of postpartum haemolysis, elevated liver enzymes, low platelets (HELLP)
syndrome in a prospective mixed randomised/non-randomised clinical investigation
of patients with postpartum HELLP syndrome by Isler et al 1.
Although the time to discharge from the obstetrical recovery room was not statistically
significant between the groups, reduction in mean arterial blood pressure was
more pronounced in the dexamethasone group as compared with the betamethasone
group (-15.3±1.4 mmHg vs. -7.5±1.4 mmHg, respectively, P<0.01).
Patients in the dexamethasone group required less antihypertensive treatment
than the betamethasone group (6% vs. 50%, P=0.01) and also had a decreased need
for readmission to the obstetrical recovery room (0% vs. 22%, P=0.03).
This investigation supports the use of dexamethasone as the superior glucocorticoid
to use for patients with postpartum HELLP syndrome.
1. Isler C. M., Magann E. F., Rinehart B. K. Terrone, D. A Bass, J. D., Martin
Jr J. N .
Dexamethasone compared with betamethasone for glucocorticoid treatment of postpartum
HELLP syndrome. International Journal of Gynecology & Obstetrics Volume
80, Issue 3 , March 2003, Pages 291-297.
Hysterectomy predisposes to thyroid cancer.
A recent paper from Finland 1 showed that women who have undergone hysterectomy
have an increased risk of thyroid cancer during the first 2 years after the
operation. Thyroid cancer and bleeding disorders may share a common background.
Women (n=17,900) undergoing hysterectomy between 1986 to 1995 were included
from the National Hospital Discharge Registry.
There were 118 cases of thyroid cancer diagnosed: 103 papillary and 15 follicular
or medullar type. The incidence for thyroid cancer was significantly elevated
(standardized incidence ratio [SIR] 1.38, 95% CI 1.15-1.64). The increase in
the incidence of thyroid cancer was not dependent on the extent of operation
but on the length of follow-up. Thyroid cancer incidence was increased 0.5 to
1.4 years after hysterectomy (SIR 2.00, 95% CI 1.31-2.93), but decreased thereafter
(SIR 1.30, 95% CI 0.99-1.67). Hysterectomy with or without oophorectomy was
associated with a similar increase in the incidence of thyroid cancer.
1.Riitta Luoto , Seija Grenman , Salla Salonen and Eero Pukkala. Increased risk of thyroid cancer among women with hysterectomies. Am J Obstet Gynecol 2003; 188:45-8.
CONFERENCE REPORTS....CONFERENCE REPORTS.....CONFERENCE REPORTS
Sexual health was on the agenda again in Middlesbrough, England.
More than 100 delegates from all over the country gathered at the 4th Teesside Sexual Health Conference on the 15th of March 2003. The event took place at The James Cook University Hospital Education Centre.
The event was chaired by Professor Brian Gazzard and the delegates included hospital doctors, general practitioners, hospital and practice nurses, and sixth form college students around Middlesbrough. The one day conference provided an opportunity for delegates to learn from each other by sharing knowledge and expertise on sexual health matters. This hopefully will help shatter the stigma associated with sexually transmitted infections.
The morning session was devoted to lectures while after lunch; the afternoon was occupied by two workshops- abortion and child sexual abuse. Wendy Shepherd from SECOS project of Barnados started with a lecture on Prostitution in the UK, and this was followed by a lecture on Menopause by Mr. Ibrahim Bolaji.
The lecture by Mike Waugh from General Infirmary at Leeds was on: Sexually
Transmitted Infections: The global perspective. It may be summarised thus: From
1984 onwards I was the Secretary General of the International Union against
the Venereal Diseases and Treponematoses, IUVDT becoming its President from
1995 to 1999. It was renamed in Melbourne in 1997 IUSTI. STI stands for Sexually
Transmitted Infections emphasising not just STDs but HIV/AIDS. In the last 4
years, I have been liasing with the International Dermatological Societies as
they have realised at long last that the only true dermatology in the developing
world is that of public health which of course includes STDs and HIV/AIDS .In
fact outside UK, most practice dermatovenereology. In recent years, I have travelled
in and been greatly interested in problems of STIs in Tanzania, Eastern Europe
and Russia, south-eastern Asia and China. Hopefully in the next few months I
shall be travelling to Sri Lanka and Myanmar to review local situations. Where
there are human beings there are STIs. For over 20 years the problems of ever
increasing HIV/AIDS have been omnipresent. It however has been realised that
contracting a STD be it ulcerative or purulent increases the risk of contracting
HIV. So a strategy practised from developed countries such as ours and from
countries in the Tropics such as Thailand is to try to cut back the numbers
of people with STDs in order to limit the increasing prevalence of HIV. In the
latter case the campaign is beginning to work. But the human situation is such
that something is always around the corner to throw a spanner in the works.
In the case of Asia, India has a huge problem with STDs. There is a real increase
on a large scale of STDs in China coupled with a rise in HIV infections. Just
when Russia had got over its syphilis epidemic, then comes along HIV/AIDS! The
problems of Africa are awful. Many countries have minimal resources. I will
tell you about what you actually find and not what health ministers would like
you to hear. There are signs that Europe is in a worse situation than might
be thought. Young people especially those who are poorly educated, migrants,
and gaymen are vulnerable to STDs. However new diagnostic and therapeutic interventions
if used sensibly will help. Migration, poverty, youth, ignorance, politics,
love and lust are all peculiarities of humanity, which help STDs, and in this
background will take place during this talk.
Like Candice something is always just about to get better, not pessimism but
a pragmatic approach to the human situation.
The final lecture was given by Brian Gazzard from Chelsea and Westminster Hospital,
London. He spoke on HIV/AIDS Epidemic: State of the Art. Among what he said
was: The advent of highly active antiretroviral therapy (HAART) has revolutionised
the prognosis of HIV infected individuals. All such regimes give broadly similar
results in terms of surrogate marker outcomes. At present the choices are, therefore,
largely driven by issues such as ease of adherence and perceived toxicity profile.
It is clear from treatment of hypertension that regimens which consist of medication
more than twice a day are less acceptable to patients. There is a considerable
move to provide once a day regimen. There may also be considerable advantages
in using combination pills, as patients are therefore unable to take part of
the medication only. The recent ACTG 384 study certainly suggests the major
side effects causing anxiety to patients, i.e. lipodystrophy, occurs with most
present regimes although more rapidly with Protease Inhibitors containing ones.
These are also more likely to be associated with lipid abnormalities. There
is a controversy as to the relative importance of the nucleoside analogue backbone
in generating the syndrome of fat redistribution and the relative importance
of the abnormal lipid profile and the development of atherosclerosis. The “when
to start” controversy is unlikely to abate until strategic trials have
been performed. The Medical Research Council (MRC) is developing such a study
(TEMPO) and the CPCRA study (SMART) is being performed in this country as well.
In the absence of definite data, the conservative British view that it is probably
best to start therapy relatively late when the risk of opportunistic infections
is high has so far been vindicated. This is partly because patients seem to
be protected from opportunistic infections by the residual immune function.
In addition, surrogate marker responses, in particular viral load undetectability,
are equally good in patients at all stages.
This is provided that treatment is started before CD4 count has fallen bellow
200 cells /mm3. Following a sumptuous lunch, the two workshops abortion and
child sexual abuse gave the facilitators and the delegates opportunities to
learn from one another and to express their views on these two important topics.
The conference was well enjoyed by the invited speakers and the delegates.
Some of the college students remarked that it was an eye opener for them and
were glad to have participated in the events. One of the students Jenny Hutton
volunteered to give a feedback from her group after one of the workshops.
It was indeed a successful conference.
Abayomi Opaneye
©2001 Sexual Health Matters. Published Quarterly by Express Print Works, Middlesbrough,
UK
ISSN 1469-7556
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